1/445. Endometrial ossification associated with secondary infertility. A patient with secondary infertility and endometrial ossification after a spontaneous is described. The aetiology and pathogenesis of endometrial ossification are discussed. ( info) |
2/445. Lysis of uterine adhesions with the four-channel hysteroscope. hysteroscopy with direct visualization of the uterine cavity has made intrauterine surgery easier and safer. Most hysteroscopes have one operating channel. This report illustrates the four-channel Baggish-Weck hysteroscope, which allows simultaneous clearing of the surgical field and lysis of adhesions. ( info) |
3/445. Endometrial fluid collection in women with PCOS undergoing ovarian stimulation for IVF. A report of four cases. BACKGROUND: The presence of endometrial fluid collections' developing during ovarian-stimulation was previously reported to occur in women with hydrosalpinx. We report on the occurrence of endometrial fluid collections in four women with polycystic ovary syndrome (PCOS) undergoing ovarian stimulation for in vitro fertilization. CASES: Four women developed endometrial fluid collections during ovarian stimulation. These fluid collections were noted as early as day 5 of stimulation. The reproductive outcome when fluid collections were noted on the day of human chorionic gonadotropin (hCG) or of embryo transfer (ET) was poor. One of three women with fluid collection on the day of hCG conceived but had a missed abortion. One patient with fluid on the day of ET failed to conceive. Three of four patients who underwent repeat cycles conceived when no fluid collections were seen on day of hCG or ET. CONCLUSION: Abnormal endometrial milieu could be an underlying defect in some women with PCOS and chronic anovulation who fail to conceive with ovulation-induction agents. This is the first report of endometrial fluid collections in patients with PCOS in the absence of hydrosalpinx. Continuous monitoring of the endometrial lining during ovulation induction is mandatory to rule out any abnormality in endometrial development. Cryopreserving all embryos may be considering in cycles with fluid collections noted on the day hCG or ET. ( info) |
| In rare cases of extreme uterine enlargement, hysterectomy by vaginal and laparoscopic-assisted techniques is not feasible and requires a large abdominal incision. hand-assisted laparoscopy permits the performance of such cases through a much smaller, glove-size abdominal incision while preserving pneumoperitoneum. In a 45-year-old nullipara with a grossly enlarged, impacted uterus and total vaginal obliteration, hysterectomy was safely performed by hand-assisted laparoscopy using the Pneumo Sleeve system through a 7. 5-cm transverse suprapubic incision, and a 1-cm laparoscopic incision. The operation lasted 150 minutes, blood loss was 220 ml, and the specimen weighed 3050 g. The patient was discharged in excellent condition on the second postoperative day and had an uneventful recovery. (J Am Assoc Gynecol Laparosc 6(2):183-188, 1999) ( info) |
5/445. Pelvic arterial embolization for control of obstetric hemorrhage: a five-year experience. OBJECTIVE: Obstetric hemorrhage is a significant cause of maternal morbidity and death. postpartum hemorrhage that cannot be controlled by local measures has traditionally been managed by bilateral uterine artery or hypogastric artery ligation. These techniques have a high failure rate, often resulting in hysterectomy. In contrast, endovascular embolization techniques have a success rate of >90%. An additional benefit of the latter procedure is that fertility is maintained. We report our experience at Stanford University Medical Center in which this technique was used in 6 cases within the past 5 years. STUDY DESIGN: Six women between the ages of 18 and 41 years underwent placement of arterial catheters for emergency (n = 3) or prophylactic (n = 3) control of postpartum bleeding. Specific diagnoses included cervical pregnancy (n = 1), uterine atony (n = 3), and placenta previa and accreta (n = 2). RESULTS: Control of severe or anticipated postpartum hemorrhage was obtained with transcatheter embolization in 4 patients. A fifth patient had balloon occlusion of the uterine artery performed prophylactically, but embolization was not necessary. In a sixth case, bleeding could not be controlled in time, and hysterectomy was performed. The only complication observed with this technique was postpartum fever in 1 patient, which was treated with antibiotics and resolved within 7 days. CONCLUSIONS: uterine artery embolization is a superior first-line alternative to surgery for control of obstetric hemorrhage. Use of transcatheter occlusion balloons before embolization allows timely control of bleeding and permits complete embolization of the uterine arteries and hemostasis. Given the improved ultrasonography techniques, diagnosis of some potential high-risk conditions for postpartum hemorrhage, such as placenta previa or accreta, can be made prenatally. The patient can then be prepared with prophylactic placement of arterial catheters, and rapid occlusion of these vessels can be achieved if necessary. ( info) |
6/445. Vesicouterine fistula after manual removal of placenta in a woman with previous cesarean section. Vesicouterine fistula is one of the less common acquired urogenital fistula and a rare event in obstetrics. We report a case which occurred after a vaginal delivery followed by manual removal of placenta in a woman who had a previous cesarean section. The fistula was successfully repaired 5 weeks after delivery. ( info) |
7/445. Laparoscopic treatment of vesicouterine fistula. Vesicouterine fistula are rare disorders that are most commonly repaired by laparotomy. A specific type of vesicouterine fistula, vesicocervical fistula, was repaired successfully by laparoscopy. This procedure was associated with minimal blood loss and morbidity, and the patient's hospital stay was less than 24 hours. (J Am Assoc Gynecol Laparosc 6(3):339-341, 1999) ( info) |
8/445. Hydrometrocolpos and polydactyly: a common neonatal presentation of Bardet-Biedl and McKusick-Kaufman syndromes. McKusick-Kaufman syndrome (MKKS) is a rare, recessively inherited syndrome reported mainly in young children and is characterised by vaginal atresia with hydrometrocolpos, postaxial polydactyly, and congenital heart defect. bardet-biedl syndrome (BBS) is the generic name for a genetically heterogeneous group of autosomal recessive disorders characterised by retinal dystrophy or retinitis pigmentosa (appearing usually between 10 and 20 years of age), postaxial polydactyly, obesity, nephropathy, and mental disturbances, or, occasionally, mental retardation. Typically, MKKS is diagnosed (and reported) in very young children, whereas the diagnosis of BBS often is delayed to the teenage years. We report here a series of nine patients diagnosed in infancy with MKKS because of the presence of vaginal atresia and postaxial polydactyly, who later developed obesity and retinal dystrophy, thus turning out to be instances of BBS. The overlap of BBS and MKKS is a real diagnostic pitfall and its importance has to be stressed, for genetic counselling, for clinical management and follow up, and for molecular approaches. The diagnosis of MKKS should be considered with caution in all published cases described exclusively in the neonatal period and in those with mental retardation. We strongly recommend all children seen in infancy with a diagnosis of MKKS to be re-evaluated for RP and other signs of BBS. ( info) |
9/445. Generalized peritonitis with pneumoperitoneum caused by the spontaneous perforation of pyometra without malignancy: report of a case. Spontaneous perforation is a very rare complication of pyometra. We report herein the case of an 88-year-old woman who presented with muscular rigidity and free air on abdominal X-ray films. Perforation of the gastrointestinal tract was diagnosed preoperatively, and an emergency laparotomy was performed. A total hysterectomy with bilateral salpingo-oophorectomy was carried out under the diagnosis of generalized peritonitis caused by the spontaneous perforation of pyometra. The culture of purulent fluid from the abdominal cavity showed only escherichia coli, with no anaerobic bacteria. Histological examination revealed pyometra with necrosis of the endometrium and no evidence of malignancy. The patient was discharged on postoperative day 68 without any major complications. pyometra is an unusual cause of peritonitis, but it must be considered as a possible diagnosis in elderly women presenting with an acute abdomen. Following this case report, we discuss the problems associated with establishing a correct preoperative diagnosis of generalized peritonitis caused by the spontaneous perforation of pyometra. ( info) |
10/445. Spontaneous closure of vesicouterine fistula. Account for effective hormonal treatment. OBJECTIVES: To analyze the incidence of spontaneous closure, or non-surgical resolution, of vesicouterine fistula and discuss the resultant implications for the management. methods: review of the literature supplemented by case report of a young woman with spontaneous healing of vesicouterine fistula. RESULTS: This is the 41st patient with spontaneous closure of vesicouterine fistula reported to date. Her clinical course was suggestive of endocrine involvement in the lesion's formation. Spontaneous healing was observed in 5% of 796 vesicouterine fistula cases. Induction of amenorrhea was effective in 8 (89%) of the 9 patients treated, a rate significantly higher (p < 0.001) than that observed without hormonal manipulation (4%). CONCLUSIONS: Conservative management by means of hormonal treatment should be considered before surgical repair. We suggest the role of estrogens and the endometrium in the formation of vesicouterine fistulas. ( info) |